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CMS Announces GUIDE Model for Medicare Beneficiaries with Dementia

The Centers for Medicare and Medicaid Services (CMS) announced on July 31st that it is launching a new care and payment model for Medicare beneficiaries with dementia: the Guiding an Improved Dementia Experience (GUIDE) Model. With the aim of helping individuals with dementia to remain in their homes, the Model will test an alternative payment arrangement for providers that deliver supportive services to people with dementia, including assessments, care plans, care coordination, and 24/7 access to a support line. People with dementia and their caregivers will have access to an interdisciplinary team, including a trained care navigator and experienced clinician, who will help them access both clinical and non-clinical services. The Model will also help caregivers to access education, support, and respite services.

The Model will serve Medicare fee-for-service beneficiaries with a diagnosis of dementia who are enrolled in Parts A and B and not enrolled in any type of Medicare Advantage Plan or Program of All-Inclusive Care for the Elderly (PACE program). Hospice patients and nursing home residents are similarly not eligible for the program.

Letters of Interest from providers seeking to participate in the GUIDE Model are due by Sept. 15, 2023. Letters are non-binding. To participate in the Model, a provider must be a Medicare Part B-enrolled provider/supplier, eligible to bill for Medicare Physician Fee Schedule services, and able to meet the care delivery requirements of the Model. Prospective participants who cannot meet the delivery requirements alone may contract with other providers/suppliers to do so.

CMS will host a webinar on Aug. 10th at 2 p.m. to provide more information on the GUIDE Model. Registration is open here. Details about the Model and the Letter of Interest are available here.

Contact: Karen Lipson, klipson@leadingageny.org